Provider Demographics
NPI:1225003858
Name:BAKER, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WEST GORE STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806
Mailing Address - Country:US
Mailing Address - Phone:407-245-3124
Mailing Address - Fax:407-245-3125
Practice Address - Street 1:100 WEST GORE STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806
Practice Address - Country:US
Practice Address - Phone:407-245-3124
Practice Address - Fax:407-245-3125
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0045006174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047744300Medicaid
FL0623717OtherAETNA HMO
FL110077293OtherRAILROAD MEDICARE
FL209241OtherAVMED
FL2300125OtherAETNA PPO
FL2900082OtherUNITED HEALTHCARE
FL47780OtherBCBS
FL2300125OtherGHI
FL810252439OtherPHCS
FL810252439OtherPHCS
FLK8293Medicare ID - Type Unspecified